24, 28
The regulatory direction of travel is restrictive: ancillary testing on venoarterial support is being withdrawn as insufficiently validated just as pooled practice relies on it most. Attempt the apnoea test; use ancillary testing to support a determination rather than to rescue one; and know which ancillary tests your own jurisdiction still permits on a circuit.
The permitted ancillary tests before and after the change
DOI 10.1007/s00101-026-01695-x
Brain-death determination before and after the directive update
Eight patients at one hospital under one national framework; the directive described applies in that country only. Structured abstract only. [VERIFICATION REQUIRED]
The updated directive requires that apnoea testing in potential donors on extracorporeal support be accompanied by physicians familiar with ECMO, and no longer permits cerebral blood flow-based methods as ancillary tests in potential donors on venoarterial ECMO, on the grounds that they are insufficiently validated in that setting. Brain death was determined in 7 of 8 donors and 4 donations were utilised (15% of all donors in the period). Apnoea testing was performed safely in all cases although the carbon dioxide tension varied with the sampling site. Cerebral circulatory arrest was demonstrated in three cases before the update; afterwards a flat-line electroencephalogram was obtained in four, and in one case the electroencephalogram was inconclusive because of artefact.
8 potential organ donors on venoarterial ECMO at one university hospital, 2021-2024, spanning a change in the national brain-death directive